Provider Demographics
NPI:1497702062
Name:DUNKLEY, BRIAN LYNN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LYNN
Last Name:DUNKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER SUNNYSIDE MEDICAL OFFICE
Mailing Address - Street 2:10180 SE SUNNYSIDE RD
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9764
Mailing Address - Country:US
Mailing Address - Phone:503-813-2000
Mailing Address - Fax:
Practice Address - Street 1:KAISER SUNNYSIDE MEDICAL OFFICE
Practice Address - Street 2:10180 SE SUNNYSIDE RD
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9764
Practice Address - Country:US
Practice Address - Phone:503-813-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD161082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR016886Medicaid
OR016886Medicaid
OR00WCGJFIMedicare ID - Type Unspecified